Ileosigmoid knotting in Gondar teaching hospital north-west Ethiopia

A retrospective analysis of nine consecutive cases of ileosigmoid knotting (ISK) that were seen at Gondar hospital from 1993 to 1995 is presented. Ileosigmoid knotting is a condition in which the ileum and the sigmoid entangle each other to form a knot and become gangrenous. It was found that the clinical features of ISK were the results of combination of symptoms and signs of small and large bowel obstruction. The presentations were so dramatic that the majority of patients deteriorated rapidly with 44% (4/9) developing shock because of gangrene of both the ileum and the sigmoid. Abdominal cramps, vomiting and absolute constipation occurred in all patients. Five patients were in shock at the time of presentation and six had peritonitis at the time of surgery. Release of the knot could easily be attained by needle deflation of the sigmoid colon. Hartman's procedure with resection of the sigmoid and ileotransversostomy by closing the distal viable stump of the ileum is recommended. Four patients out of the nine patients died.